title: Incidence and analysis of open fractures of the midshaft and distal femur.
abstract: BACKGROUND
  The purpose of this study was to determine whether different forms of stabilization for open femur fractures can be performed without influencing outcome, in particular infection and delayed unions/nonunions. Although the traditional management of these injuries is external fixation, a trend toward definitive stabilization techniques has evolved in the current literature.
  
  
  METHODS
  All open fractures of the femur shaft and the distal femur presenting to our urban Level I trauma center during a 10 year period were reviewed. A total of 40 patients (41 fractures) were initially treated at the above institution within 6 h of injury. All patients underwent emergent wound irrigation, debridement, and antibiothic theraphy. The method of fracture immobilization was left to the discretion of the attending trauma surgent. Study population consited of 12 (29 %) GI, 10 (25 %) GII, and 19 (46 %) GIII fractures.
  
  
  RESULTS
  Initially, fracture management was performed with external fixation (EF) 19 (43.2 %), intramedullary nailing (IM) 18 (38.6 %), plating (PL) 3 (6.8 %), screw fixation (SF) 1 (2.3 %) and without treatment 4 (9.1 %). In all, 3 (6.8 %) fractures were complicated by infection, 7 (15.9 %) had implant failure, and 5 (11.4 %) developed delayed union.
  
  
  CONCLUSIONS
  Using external fixation in acute fracture treatment for open femur fractures is a safe and effective surgical technique. Based on our results, external fixation might be superior to intramedullary nailing or plating when evaluating outcome parameters and complications.
authors.affiliation: Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria. florian.kovar@meduniwne.ac.at
authors.forename: Florian M
authors.initials: FM
authors.lastname: Kovar
authors.forename: Manuela
authors.initials: M
authors.lastname: Jaindl
authors.forename: Rupert
authors.initials: R
authors.lastname: Schuster
authors.forename: Georg
authors.initials: G
authors.lastname: Endler
authors.forename: Patrick
authors.initials: P
authors.lastname: Platzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016267:External Fixators / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology* / Q000628:therapy*; D005597:Fractures, Open / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D007103:Immobilization / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult